Most Relevant Information
Provider Data
| NPI Number: | 1003676651 |
| Provider Name: | KATE LOUISE RUSSELL-BOGAN |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/20/2024 |
| Last Updated: | 03/20/2024 |
Provider Practice Location
160 E VIRGINIA ST STE 100
SAN JOSE
CA
951125865
Practice Location Phone/Fax
| Phone: | 0849382113 |
| Fax: | 4085796143 |
Provider Mailing Location
160 E VIRGINIA ST STE 100
SAN JOSE
CA
951125865
Provider Mailing Phone/Fax
| Phone: | 0849382113 |
| Fax: | 4085796143 |